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Isthmus endoprosthesis stent-graft treatment: implantation of relay dedicated device
Alessandro S Bortone1, Emanuela de Cillis, Donato D'Agostino
1Institute of Cardiac Surgery, Department of Emergency and Transplantation, University of Bari School of Medicine, Bari, Italy.
Insights
Endovascular stent grafts for aortic isthmus disease require improved conformability. New devices designed for the aorta's "double S" anatomy may increase durability and reduce complications.
Area of Science:
- Cardiovascular Surgery
- Medical Device Engineering
Background:
- Aortic isthmus disease is prevalent, often misdiagnosed as descending aortic disease.
- Current thoracic stent grafts lack compliance, mismatching the aorta's semi-compliant nature.
Observation:
- The aortic isthmus has a unique "double S" morphology.
- Existing stent grafts exert torsional forces due to noncompliance and power transmission angles.
Findings:
- A new generation of endoprostheses is being developed with increased conformability to patient anatomy.
- The novel stent graft aims to accommodate the isthmus's "double S" configuration and torsional forces.
Implications:
- Improved stent graft design may enhance durability and reduce endovascular treatment complications.
- Arch-compatible delivery systems are crucial for precise, three-dimensional device orientation.
Abstract:
Among the 123 patients treated in our department by endovascular stent graft, 113 (91.8%) were identified as having involvement of the isthmus. Therefore, the incorrectly defined descending aortic disease is essentially a pathology of the isthmus that represents the distal portion of the arch. The key to the treatment of all types of aortic lesions rests on understanding the morphology of this region gifted with a "double S" configuration. Current thoracic devices are noncompliant systems and should be modified greatly, taking into account that the media of the aorta has a semi-compliant behavior. The resultant of power transmission is oriented at 45 degrees and produces a transmural radial force that animal implantation has demonstrated to be a torsional movement. The improvements in new devices actually result in a new generation of endoprostheses that seem to be closely related to the anatomy of the patient by increasing the conformability and, therefore, we expect an increase in durability. To test these features, we have studied a new stent graft in different settings of thoracic aortic disease. The new device should conform to current standards while simultaneously transmitting torsional forces. The dedicated delivery system should be arch-compatible, flexible but sufficiently rigid, and able to be three-dimensionally oriented. Moreover, the new stent graft should follow the three-dimensional anatomy of the "double S" configuration of the isthmus area and thus reduce the mismatch between the aorta and the device itself.
